Provider Demographics
NPI:1750760369
Name:WOMEN RESTORE LLC
Entity type:Organization
Organization Name:WOMEN RESTORE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MISTY
Authorized Official - Middle Name:G
Authorized Official - Last Name:GALBRAITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-787-7007
Mailing Address - Street 1:1171 EXPRESSWAY LN
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84660-1331
Mailing Address - Country:US
Mailing Address - Phone:801-787-7007
Mailing Address - Fax:801-210-2989
Practice Address - Street 1:1171 EXPRESSWAY LN
Practice Address - Street 2:
Practice Address - City:SPANISH FORK
Practice Address - State:UT
Practice Address - Zip Code:84660-1331
Practice Address - Country:US
Practice Address - Phone:801-787-7007
Practice Address - Fax:801-210-2989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-28
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier